Graduated compression stockings as prophylaxis for flight-related venous thrombosis: systematic literature review

In-Season Nutrition Strategies and Recovery Modalities to Enhance Recovery for Basketball Players: A Narrative Review

Basketball players face multiple challenges to in-season recovery. The purpose of this article is to review the literature on recovery modalities and nutritional strategies for basketball players and practical applications that can be incorporated throughout the season at various levels of competition. Sleep, protein, carbohydrate, and fluids should be the foundational components emphasized throughout the season for home and away games to promote recovery. Travel, whether by air or bus, poses nutritional and sleep challenges, therefore teams should be strategic about packing snacks and fluid options while on the road. Practitioners should also plan for meals at hotels and during air travel for their players. Basketball players should aim for a minimum of 8 h of sleep per night and be encouraged to get extra sleep during congested schedules since back-to back games, high workloads, and travel may negatively influence night-time sleep. Regular sleep monitoring, education, and feedback may aid in optimizing sleep in basketball players. In addition, incorporating consistent training times may be beneficial to reduce bed and wake time variability. Hydrotherapy, compression garments, and massage may also provide an effective recovery modality to incorporate post-competition. Future research, however, is warranted to understand the influence these modalities have on enhancing recovery in basketball players. Overall, a strategic well-rounded approach, encompassing both nutrition and recovery modality strategies, should be carefully considered and implemented with teams to support basketball players' recovery for training and competition throughout the season.

Compression stockings for preventing deep vein thrombosis in airline passengers

BACKGROUND

Air travel might increase the risk of deep vein thrombosis (DVT). It has been suggested that wearing compression stockings might reduce this risk. This is an update of the review first published in 2006.

OBJECTIVES

To assess the effects of wearing compression stockings versus not wearing them for preventing DVT in people travelling on flights lasting at least four hours.

SEARCH METHODS

The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL and AMED databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 1 April 2020. We also checked the bibliographies of relevant studies and reviews identified by the search to check for any additional trials.

SELECTION CRITERIA

Randomised trials of compression stockings versus no stockings in passengers on flights lasting at least four hours. Trials in which passengers wore a stocking on one leg but not the other, or those comparing stockings and another intervention were also eligible.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion and extracted data. We sought additional information from trialists where necessary.

MAIN RESULTS

One new study that fulfilled the inclusion criteria was identified for this update. Twelve randomised trials (n = 2918) were included in this review: ten (n = 2833) compared wearing graduated compression stockings on both legs versus not wearing them; one trial (n = 50) compared wearing graduated compression tights versus not wearing them; and one trial (n = 35) compared wearing a graduated compression stocking on one leg for the outbound flight and on the other leg on the return flight. Eight trials included people judged to be at low or medium risk of developing DVT (n = 1598) and two included high-risk participants (n = 1273). All flights had a duration of more than five hours. Fifty of 2637 participants with follow-up data available in the trials of wearing compression stockings on both legs had a symptomless DVT; three wore stockings, 47 did not (odds ratio (OR) 0.10, 95% confidence interval (CI) 0.04 to 0.25, P < 0.001; high-certainty evidence). There were no symptomless DVTs in three trials. Sixteen of 1804 people developed superficial vein thrombosis, four wore stockings, 12 did not (OR 0.45, 95% CI 0.18 to 1.13, P = 0.09; moderate-certainty evidence). No deaths, pulmonary emboli or symptomatic DVTs were reported. Wearing stockings had a significant impact in reducing oedema (mean difference (MD) -4.72, 95% CI -4.91 to -4.52; based on six trials; low-certainty evidence). A further three trials showed reduced oedema in the stockings group but could not be included in the meta-analysis as they used different methods to measure oedema. No significant adverse effects were reported.

AUTHORS' CONCLUSIONS

There is high-certainty evidence that airline passengers similar to those in this review can expect a substantial reduction in the incidence of symptomless DVT and low-certainty evidence that leg oedema is reduced if they wear compression stockings. The certainty of the evidence was limited by the way that oedema was measured. There is moderate-certainty evidence that superficial vein thrombosis may be reduced if passengers wear compression stockings. We cannot assess the effect of wearing stockings on death, pulmonary embolism or symptomatic DVT because no such events occurred in these trials. Randomised trials to assess these outcomes would need to include a very large number of people.

Effects of Sports Compression Socks on Performance, Physiological, and Hematological Alterations After Long-Haul Air Travel in Elite Female Volleyballers

Broatch, JR, Bishop, DJ, Zadow, EK, and Halson, S. Effects of sports compression socks on performance, physiological, and hematological alterations after long-haul air travel in elite female volleyballers. J Strength Cond Res 33(2): 492-501, 2019-The purpose of this investigation was to assess the merit of sports compression socks in minimizing travel-induced performance, physiological, and hematological alterations in elite female volleyball athletes. Twelve elite female volleyballers (age, 25 ± 2 years) traveled from Canberra (Australia) to Manila (Philippines), and were assigned to 1 of 2 conditions; compression socks (COMP, n = 6) worn during travel or a passive control (CON, n = 6). Dependent measures included countermovement jump (CMJ) performance, subjective ratings of well-being, cardiovascular function, calf girth, and markers of blood clotting, collected before (-24 hours, CMJ; -12 hours, all measures), during (+6.5 and +9 hours, subjective ratings and cardiovascular function), and after (+12 hours, all measures except CMJ; +24 hours and +48 hours, CMJ) travel. When compared with CON, small-to-large effects were observed for COMP to improve heart rate (+9 hours), oxygen saturation (+6.5 hours and +9 hours), alertness (+6.5 hours), fatigue (+6.5 hours), muscle soreness (+6.5 hours and +9 hours), and overall health (+6.5 hours) during travel. After travel, small-to-moderate effects were observed for COMP to improve systolic blood pressure (+12 hours), right calf girth (+12 hours), CMJ height (+24 hours), mean velocity (+24 hours), and relative power (+48 hours), compared with CON. COMP had no effect on the markers of blood clotting. This study suggests that compression socks are beneficial in combating the stressors imposed by long-haul travel in elite athletes, and may have merit for individuals frequenting long-haul travel or competing soon after flying.

Compression stockings for preventing deep vein thrombosis in airline passengers

BACKGROUND

Air travel might increase the risk of deep vein thrombosis (DVT). It has been suggested that wearing compression stockings might reduce this risk. This is an update of the review first published in 2006.

OBJECTIVES

To assess the effects of wearing compression stockings versus not wearing them for preventing DVT in people travelling on flights lasting at least four hours.

SEARCH METHODS

For this update the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (10 February 2016). In addition, the CIS searched the Cochrane Register of Studies (CENTRAL (2016, Issue 1)).

SELECTION CRITERIA

Randomised trials of compression stockings versus no stockings in passengers on flights lasting at least four hours. Trials in which passengers wore a stocking on one leg but not the other, or those comparing stockings and another intervention were also eligible.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials for inclusion and extracted data. We sought additional information from trialists where necessary.

MAIN RESULTS

One new study that fulfilled the inclusion criteria was identified for this update. Eleven randomised trials (n = 2906) were included in this review: nine (n = 2821) compared wearing graduated compression stockings on both legs versus not wearing them; one trial (n = 50) compared wearing graduated compression tights versus not wearing them; and one trial (n = 35) compared wearing a graduated compression stocking on one leg for the outbound flight and on the other leg on the return flight. Eight trials included people judged to be at low or medium risk of developing DVT (n = 1598) and two included high-risk participants (n = 1273). All flights had a duration of more than five hours.Fifty of 2637 participants with follow-up data available in the trials of wearing compression stockings on both legs had a symptomless DVT; three wore stockings, 47 did not (odds ratio (OR) 0.10, 95% confidence interval (CI) 0.04 to 0.25, P < 0.001; high-quality evidence). There were no symptomless DVTs in three trials. Sixteen of 1804 people developed superficial vein thrombosis, four wore stockings, 12 did not (OR 0.45, 95% CI 0.18 to 1.13, P = 0.09; moderate-quality evidence). No deaths, pulmonary emboli or symptomatic DVTs were reported. Wearing stockings had a significant impact in reducing oedema (mean difference (MD) -4.72, 95% CI -4.91 to -4.52; based on six trials; low-quality evidence). A further two trials showed reduced oedema in the stockings group but could not be included in the meta-analysis as they used different methods to measure oedema. No significant adverse effects were reported.

AUTHORS' CONCLUSIONS

There is high-quality evidence that airline passengers similar to those in this review can expect a substantial reduction in the incidence of symptomless DVT and low-quality evidence that leg oedema is reduced if they wear compression stockings. Quality was limited by the way that oedema was measured. There is moderate-quality evidence that superficial vein thrombosis may be reduced if passengers wear compression stockings. We cannot assess the effect of wearing stockings on death, pulmonary embolism or symptomatic DVT because no such events occurred in these trials. Randomised trials to assess these outcomes would need to include a very large number of people.

Efficacy of micromobile foot compression device in increasing lower limb venous blood flow

Background. A novel, micromobile foot compression device (MMC) has been developed to reduce the risk of venous thromboembolism associated with prolonged seated immobility. Objective. To compare the efficacy of the MMC with graduated compression stockings in augmenting lower limb venous blood flow. Patients/Methods. Twenty participants were randomised to wear the MMC or a graduated compression stocking (GCS) on either the left or right leg while seated. Doppler ultrasound measurements of popliteal vein blood flow and leg circumference measurements were made -30 and -10 minutes (baseline) and +30 and +60 minutes following application of the interventions. The primary outcome variable was peak systolic velocity. A mixed linear model was used, with covariates including baseline measurement, randomised side, time, and a time by interaction term. Results. The mean popliteal vein peak systolic velocity at 60 minutes with the MMC was 20.1 cm/s which was significantly higher than with the GCS (difference 14.1 cm/s 95% CI 12.1-16.2), representing a 3.8-fold increase from baseline. Conclusion. The MMC resulted in a marked increase in lower limb venous blood flow which suggests that it may have efficacy in reducing the risk of venous thromboembolism associated with prolonged seated immobility, such as long distance air travel.

Knee-length graduated compression stockings for thromboprophylaxis in air travellers: A meta-analysis

OBJECTIVE

To systematically review the randomized controlled trials that have evaluated the efficacy of knee-length (KL) compression stockings for thromboprophylaxis in air travellers.

METHOD

After an electronic database search, the randomized controlled trials that studied passengers on long-haul flights were selected and analyzed to generate summative data.

RESULTS

Nine trials studying participants using KL stockings were analyzed. Forty-six of 1261 participants randomly assigned to the control group developed deep vein thrombosis (DVT), compared with two of 1237 participants (0.16%) in the KL stockings group. The weighted risk difference was -0.034, which indicated that the absolute difference was 3.4% in the incidence of DVT, in favour of KL stockings. The number needed to treat with KL stockings to avoid one case of DVT was 29.4. However, there was significant heterogeneity among trials. The RR for DVT was 0.08 in high-risk participants and 0.14 in low- to medium-risk participants.

CONCLUSION

KL stockings are effective for thromboprophylaxis in air travellers at low, medium and high risk of DVT. The use of KL stockings should form an important part of air traveller education on lowering the burden of DVT. The results of the present meta-analysis can be used to advise travellers on their risk of DVT and preventive strategies.

Merino wool graduated compression stocking increases lower limb venous blood flow: a randomized controlled trial

INTRODUCTION

Graduated compression stockings represent a nonpharmacological approach to reduce the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE) due to prolonged immobility through reducing lower limb venous stasis. A novel merino wool, double-layer, below-knee graduated compression stocking has been developed to reduce the risk of air travel-related DVT and PE.

METHODS

Twenty healthy adult participants were randomized to wear the novel graduated compression stocking on either the left or right leg. Doppler ultrasound measurements of popliteal venous blood flow were made on both legs over a 120-minute period. The primary outcome was peak systolic velocity in the popliteal vein at 120 minutes. Secondary outcomes included mean flow velocity, total volume flow, vein cross-sectional area, and change in ankle and calf measurements.

RESULTS

The popliteal vein peak systolic velocity was 0.35 cm/s (95% confidence intervals [CI], 0.22 to 0.49, P<0.001) higher with stocking use at 120 minutes, a difference of 24%. Mean flow velocity and total volume flow were also significantly higher with stocking use. Ankle and calf circumference were decreased with stocking use, with an overall difference of -6.3 mm (95% CI, -11.3 to -1.2, P=0.021) and -7.9 mm (95% CI, -13.3 to -2.4, P=0.011), respectively.

CONCLUSION

The novel merino wool double-layer, below-knee graduated compression stocking increases lower limb venous blood flow during prolonged seated immobility. Its use is likely to reduce the risk of DVT and PE in situations of prolonged seated immobility, such as long-distance air travel. The reduction in lower limb swelling associated with their use suggests that the stockings are likely to have utility in the treatment of chronic venous insufficiency and lymphedema.

Travel-related thromboembolism: mechanisms and avoidance

Evidence regarding the existence of travel-related venous thrombosis and pulmonary embolism is building. Research suggests that travel of all kinds increases the risk by two- to four-fold. Risks are not restricted to air travel alone. For travelers without any known risk factors, the risk of experiencing venous thromboembolism is likely to be very low. However, risks increase significantly in the presence of known risk factors, such as age over 60 years, thrombophilic disorders, varicose veins, history of thromboembolism, obesity, women taking oral contraceptives and travel duration over 12 h. A combination of one or more of these risk factors raises the probability of developing travel-related thromboembolism. Possible contributing factors, such as cramped sitting (with suppressed leg venous flow), moderate hypoxia, low humidity in the aircraft and dehydration, are discussed. Depending on the risk profile of individuals, the use of graduated compression stockings and/or pharmacological interventions (low-molecular-weight heparins are preferred) may be recommended.

Medical issues associated with commercial flights

Almost 2 billion people travel aboard commercial airlines every year. Health-care providers and travellers need to be aware of the potential health risks associated with air travel. Environmental and physiological changes that occur during routine commercial flights lead to mild hypoxia and gas expansion, which can exacerbate chronic medical conditions or incite acute in-flight medical events. The association between venous thromboembolism and long-haul flights, cosmic-radiation exposure, jet lag, and cabin-air quality are growing health-care issues associated with air travel. In-flight medical events are increasingly frequent because a growing number of individuals with pre-existing medical conditions travel by air. Resources including basic and advanced medical kits, automated external defibrillators, and telemedical ground support are available onboard to assist flight crew and volunteering physicians in the management of in-flight medical emergencies.

Some chronobiological and physiological problems associated with long-distance journeys

Long-distance travel is becoming increasingly common. Whatever the means of transport, any long journey will be associated with "travel fatigue". The symptoms associated with this phenomenon result from a changed routine (particularly sleep lost and meals) and the general disruption caused by travel. Planning any trip well in advance will minimise many of these problems, but some factors are less easy to guard against. These problems include sitting in cramped and uncomfortable conditions and, with flights, the hypoxic environment in the cabin. After arrival at the destination in another country, there can be problems coping with the local language, alterations in food and different customs. If the flight has crossed the equator, then there is likely to be a change in season and natural lighting and, if it has crossed several time zones, there will also be the problem of "jet lag", caused by a transient desynchrony between the "body clock" and the new local time. Moreover, the new environment might differ from the place of departure with regard to ambient temperature and humidity, altitude, natural lighting (including ultraviolet radiation) and pollution. The traveller needs to be aware of these changes before setting off, so that appropriate preparations (clothing, for example) can be made.

Foreign travel for advanced cancer patients: a guide for healthcare professionals

The opportunity for a patient with advanced cancer to travel abroad may, for some, be a life affirming event during a dark period in their life. For others, what they hoped to be a time of joy may become an unmitigated disaster if they become unwell while away from the safety net of local cancer services. The rise of low budget airlines and cheaper foreign travel has led to an increase in the number of people travelling by air. Health professionals are more likely to face requests by patients to advise them on travel plans. Although foreign travel is an unrealistic goal for some patients, appropriate forward planning and proactive management can allow some patients to make an important journey abroad. This paper looks at the practical issues facing cancer patients who intend to travel overseas and offers practical advice on considerations that need to be made.

Role of MRI in investigating the effects of elastic compression stockings on the deformation of the superficial and deep veins in the lower leg

PURPOSE

To evaluate the potential of MRI to investigate the mechanical effects of compression stockings on the veins of the lower limb.

MATERIALS AND METHODS

The right calves of eight healthy volunteers were imaged in the prone position, with and without the presence of a compression stocking. Cross-sectional areas of all peroneal and posterior tibial veins, both saphenous veins, and any sufficiently large superficial veins were segmented in all subjects at mid-calf level in both cases. Variation in cross-sectional area along the axis of the great saphenous vein and a peroneal vein was also examined in three subjects.

RESULTS

The mean cross-sectional area reduction was found to be greater in the deep veins (64%) than in the superficial veins (39%). Deep-vein cross-sections were generally elliptical, while superficial veins were approximately circular. Significant axial fluctuations were found in the cross-sectional areas.

CONCLUSION

MRI offers a precise source of data on the mechanical effects of lower-limb compression. Ultrasound (US) may be more cost-effective, but the data acquired are less comprehensive. Future biomechanical studies of lower-limb compression should make use of MRI.

Compression stockings for preventing deep vein thrombosis in airline passengers

BACKGROUND

Air travel might increase the risk of deep vein thrombosis (DVT). It has been suggested that wearing compression stockings might reduce this risk.

OBJECTIVES

To assess the effects of wearing compression stockings versus not wearing them among people travelling on flights lasting at least four hours.

SEARCH STRATEGY

We searched the Cochrane Peripheral Vascular Diseases Group's Specialized Register (January 2006), the Cochrane Central Register of Controlled Trials (CENTRAL) (in The Cochrane Library, Issue 4, 2005), MEDLINE (January 1966 to November 2005), EMBASE (January 1980 to December 2005) and several other electronic or grey literature sources, detailed in full in the review. The most recent searches were done in January 2006.

SELECTION CRITERIA

Randomized trials of compression stockings versus no stockings in passengers on flights lasting at least four hours. Trials in which passengers wore a stocking on one leg but not the other, or those comparing stockings and another intervention were also eligible.

DATA COLLECTION AND ANALYSIS

At least two authors independently assessed the quality of each study and extracted data. We sought additional information from trialists.

MAIN RESULTS

Ten randomized trials (n = 2856) were included; nine (n = 2821) compared wearing stockings on both legs versus not wearing them, and one (n = 35) compared wearing a stocking on one leg for the outbound flight and on the other leg on the return flight. Of the nine trials, seven included people judged to be at low or medium risk (n = 1548) and two included high risk participants (n = 1273). All flights lasted at least seven hours. Fifty of 2637 participants with follow-up data available in the trials of wearing stockings on both legs had a symptomless DVT; three wore stockings, 47 did not (odds ratio 0.10, 95% confidence interval 0.04 to 0.25, P < 0.00001). There were no symptomless DVTs in three trials. No deaths, pulmonary emboli or symptomatic DVTs were reported. Wearing stockings had a significant impact in reducing oedema (based on six trials). No significant adverse effects were reported.

AUTHORS' CONCLUSIONS

Airline passengers similar to those in this review can expect a substantial reduction in the incidence of symptomless DVT and leg oedema if they wear compression stockings. We cannot assess the effect of wearing stockings on death, pulmonary embolus or symptomatic DVT because no such events occurred in these trials. Randomized trials to assess these outcomes would need to include a very large number of people.